Chronic Neuropathic PAIN & topical capsaicin

I have had excellent results with topical capsaicin for trigeminal neuralgia and thought I would post here an excellent summary of several studies examining the efficacy of this substance for neuropathic pain

I'm interested in hearing more about this. I have different kinds of pain requiring different kinds of treatments. What bugs me the most is an over sensitivity in different places that is more surface. Sometimes my skin feels like a bad sunburn in different spots and I haven't been able to find how to treat it.

Lidoderm patches are a miracle to me for my mid-back injury. If I catch it early and put a half patch on, the pain just disappears. If I wait too long, maybe a larger patch will work, but probably not. Because what started as a small nerve like irritation in a very local area leads to the muscles around it trying to control the pain and then my whole back becomes unhappy.

I also have shoulder pain since my shoulder froze up about two years ago. I have more movement now, but there is still pain. Occasionally my whole arm wrists, elbow, shoulder and in between feel like they get completely inflamed.

So I'm wondering if this capsaicin might have anything to offer. Any thoughts?

October 15, 2009 (Phoenix, Arizona) A high-concentration capsaicin patch that is applied to the skin for just an hour can provide up to 3 months of pain relief for patients with postherpetic neuralgia, according to several studies presented here at the American Association of Pain Management (AAPM) 20th annual clinical meeting.

Capsaicin, the compound known for making peppers such as jalapeos hot, is commonly sold in low concentrations in creams for arthritis and other painful conditions, but the patch, called NGX-4010 and commercially marketed as Qutenza (NeurogesX, Inc.), contains 8% capsaicin, a much higher concentration than is found in over-the-counter products, Misha-Miraslav Backonja, MD, a coauthor of the studies and a professor in the Department of Neurology at the University of Wisconsin in Madison, told meeting attendees.

"There are other preparations that contain capsaicin, including gels and creams, but this is a single application [of a concentration] that is 80 times [higher] than the highest concentration in the gels or creams," he said. "The product is really different from anything else in pain medicine."

In the phase 3 studies reported at the AAPM meeting, researchers looked at the safety and efficacy of the patch. The product is already available in Europe

The first study was designed to evaluate the patch's effect on neurosensory function in patients with postherpetic neuralgia. Researchers analyzed data from 4 double-blind 12-week controlled studies that consisted of 738 patients treated with NGX-4010 (8% capsaicin w/w) and 531 control patients treated with a low-concentration capsaicin patch (0.04% capsaicin w/w).

The study also looked at data from 2 open-label repeat-treatment studies in which patients could receive up to 4 treatments over a 1-year period.

The results showed that most NGX-4010 and control patients experienced no change in light brush, pin-prick, vibration, or warmth sensations from baseline to week 12. Among those that did experience changes, the NGX-4010 patients showed improvement in light brush (21.3% vs 14.5%), vibration (24.1% vs 16.4%), pinprick (23.1% vs 20.0%), and warmth (19.6% vs 17.6%) sensations.

"There was no evidence of a problem when the product was developed, but the expected pharmacological effect was that it could lead to loss of small neurosensory fibers in the top layers of the skin," Dr. Backonja said.

"So the concern was that if something such as capsaicin in high concentrations could cause loss of nerve fibers, you might end up with loss of function, but that wasn't the case. We found that, not only was there not a loss of function, there was in fact improved function in a subset of patients. That will be something important to submit for further study."

A second study, evaluating the safety and efficacy of the patch, included data from 4 double-blind, controlled postherpetic neuralgia studies with 597 patients receiving a single NGX-4010 treatment and 530 control patients receiving the lower-dose (0.04% w/w) patches.

Over the course of the 12-week studies, the patients recorded daily ratings of pain in the previous 24 hours on an 11-point pain rating scale. The mean percentage change in the pain score was significantly greater for patients receiving the NGX-4010 patch than for those receiving the control patch during weeks 2 to 8 (31.2% vs 22.3%; P < .0001) and during weeks 2 to 12 (31.3% vs 22.6%; P < .0001).

On the secondary end point the proportion of patients with a reduction in mean Numeric Pain Rating Scale (NPRS) score that was equal to or greater than 30% the researchers found that during weeks 2 to 8, 43.6% of patients receiving the NGX-4010 patch had a significant (>30%) reduction in NPRS score, compared with 33.6% those receiving the control patch (P = .0004). From weeks 2 to 12, 44.9% of the NGX-4010 group had a significant change in NPRS score, compared with 35.3% of the control group (P = .0006).

On the Patient Global Impression of Change, results showed that those in the NGX-4010 group consistently reported being "very much" or "much" improved throughout the study, compared with the control group. At week 8, 37.3% of the NGX-4010 group and 24.8% of the control group reported they were "much" or "very much" improved. At week 12, 36.5% and 23.7% of the high-dose and control groups, respectively, reported being "much" or "very much" improved (P < .0001 for both).

The most common adverse events in the NGX-4010 group were pain around the site of the patch, with 42% reporting application site pain, compared with 19% in the control group. However, all patients were able to tolerate the treatment, Dr. Backonja said.

"I actually thought patients would not be able to tolerate the pain at the higher dose, but most patients reported pain of just about 6 or 7 on a 1- to 10-[point] scale and they were able to tolerate it."

Topical lidocaine gel is applied for an hour before the patch is applied, and ice can be used to further reduce pain from the application, which eases after about 1 to 2 days, Dr. Backonja added.

Capsaicin's mechanism of action in providing pain relief involves the activation of TRPV1 receptors on nociceptive sensory nerve fibers, resulting in a depolarization and action potential initiation. Prolonged exposure to capsaicin causes TRPV1-containing sensory axons to lose end branches and terminals, resulting in a reduction of pain transmission, according to the researchers.

The patch could play an important role in the treatment of postherpetic neuralgia, either on its own or in combination with other therapies, he said.

"This is a product that is different from anything else in pain medicine in the sense that it's a patch that's applied 1 time only and leads to prolonged pain relief," he said. "It lends itself either as a first-line treatment for localized peripheral neuropathic pain or in combination with other therapies because, being topical therapy, it requires just 1 application; after it reduces pain, the added other medicines could be used at lower doses."

The idea of capsaicin as a treatment for postherpetic neuralgia has been around for several decades; however, early experimentations were considered just too painful, said R. Norman Harden, MD, director of the Center for Pain Studies at the Rehabilitation Institute of Chicago in Illinois, who experienced the treatment first-hand.

"I found myself being 'volunteered' for one of the early capsaicin injections at the [National Institutes of Health], and I can tell you it was incredibly, intensely painful. But of course they didn't offer me any lidocaine at the time. You'd really have to have lidocaine to make it bearable."

"The concept is that capsaicin kind of sucks substance P, related to the transmission of pain information, out of the nerve endings, which makes them all fire to the point of exceeding their metabolic capability, and then they simply shut down and can't produce substance P any more," he explained.

The idea of a therapy such as the NGX-4010 patch being capable of muting pain for postherpetic neuralgia patients for 3 months would be highly welcome because of the current lack of any consistently reliable treatment, Dr. Harden added.

"Postherpetic neuralgia is one of those unmet needs in pain management," he emphasized. "With anything that's currently on the market, only about a third of people are going to get a profound relief from their pain. So this is quite encouraging."

The study received funding from NeurogesX, Inc. Dr. Backonja disclosed that he has been an investigator for NeurogesX, Inc. Dr. Harden disclosed that he has received research support from GlaxoSmithKline.

A patch containing 8% capsaicin can relieve the pain caused by peripheral neuropathy for up to three months, according to a controlled study presented on Tuesday at the Thirteenth Conference on Retroviruses and Opportunistic Infections in Denver.

I hope the above information might be useful to you. It is the most recent capsaicin study.

fingers and eyes crossed!

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Thanks Koan. I will look into your links later. I just got done with 3 hours of Judy so need to give my brain a rest. It sounds very interesting for localized pain I think they are talking about shingles? but wouldn't work for large areas of inflamation is my guess.

Using the words "fingers and eyes" right after "capsaicin" made me squirm. No fingers and eyes, please.

You sold me on capsaicin and I decided to buy some. (You don't happen to have a multi-level marketing thing going on do you? Just checking.)

I'm not finding any articles that apply to my particular case.

I want to try it on some places on my feet. I don't even know the proper diagnosis, but I'm still going to ask your expert opinion. So . . .

Dr. Koan:

When I wear shoes (which I try to do as infrequently as possible), I have several spots on my feet that get irritated and feel like a bad sunburn later when my shoes are off, especially when lying in bed. I think it's nerve pain, but I really don't know. This burning pain, in these several spots, can be very irritating and aggravating. If I apply capsaicin, that too will cause a feeling of burning pain, is that correct? But the hope is that this pain will eventually give way to no pain as the substance P is drained out? So to start, I would be replacing one pain with the other pain but eventually I may have no pain? Is that the way it works?

If I could get rid of these pain spots, or at least lessen them, I could wear shoes more often, and gosh, you never know where that might lead!

Hi
I had the most awful nerve pain in my leg with the nerve pain sometimes shooting suddenly all over my body, even in my face. It started in my leg as a deep throbbing pain. My feet and ankles felt like they were on fire. All of this stopped me getting sleep as nothing I tried relieved it.

My doctor gave me Capsaicin cream - you have to apply it 4 times a day for at least a week. It's made of peppers so it can burn to start with.

Well after a week the pain calmed down so I could sleep. I do get flares now & then but keep the cream on hand.

It is the best I've tried for certain types of pain. It doesn't work on all pains (I know I've tried it on other FM pains) Worth a try I think.

Gracenote, so long as your skin is not broken or irritated, this should work. All pain comes from nerves, I think. So, wherever the nerve transmitting the pain is, if you deplete it of substance P it should not be able to work.

As as example of how effective this is. I just returned from having dental Xrays and have two abscesses needing root canals (sigh) but application of topical capsaicin so effectively controls the pain that, not only am I not in pain but, I barely felt it when she did the tapping the teeth thing. I'm thinking that I should probably apply liberally in the days before the root canals!

I would think that, so long as your skin is not irritated, it's certainly worth a shot. I have encountered a number of people who have gained complete relief from a number of neuropathies with Capsaicin.

Capsaicin testimonial: This is a post to Koan I sent just recently, I am status post bunionectomy and was having nerve pain as a result.

Koan, wanted to thank you for your advice on using Capsaicin for nerve pain status post bunionectomy. It helped. As I have so many side-effects from meds, I was relieved not to have to take the Lyrica.

My son (who is healthy) had terrible burning pain on his feet when he was in middle school. His feet were inflamed and bright red. He could not walk at all and had to crawl around the floor. Of course he missed a lot of school because of this. After many visits to different docs, he was diagnosed with an allergy to latex. Apparently, sneakers can have (or did have at the time) latex which breaks down over a period of time and migrates up through the innersole. The doctor recommended that my son buy new shoes every 4 months as this chemical breakdown can occur within 6 months if the shoes are worn often enough. Once we did this, he had no more problems.

Fast forward 10 years. My nephew had exact same problem. I know latex allergies are not uncommon. Folks may not know that there may be latex in their sneakers/shoes.

Wow, Hoping. That is something. How great that you found what was causing these feet problems.

Mine is different and is brought on by skin contact where the shoe hits, if my sock is too tight. It started at the top of my feet where the shoe hits when walking. Wearing shoes that don't hit this will allow it to settle down, but just a very short while with this spot being touched will set it off again. If I start wearing short boots, pretty soon my ankle bones where it touches (not rubs or anything you would expect), starts the burning pain that will last long after I stop wearing said boots. Just trying on a pair of Uggs once, left me feeling a burning pain where the seam that goes across the top of the feet hit for the rest of the day.

My feet act like children in the back seat of a car you touched me. I did not. Yes you did. The discomfort is completely out of whack compared to what the aggravation is.

Hi Koan
A little miracle, yes! It certainly did the trick for my leg / feet pains - a huge help and a welcome relief.

I'd love a big enough tube that I could walk into it and it would take away all the FM pains!!:victory:
Glad it's helping with so many of your pains & thanks for writing about it here as it reminded me to get some more to keep on hand.
Diva

Gosh Hoping, that's fascinating! I have a latex allergy, too, but it's mild ~ thank heavens! It's amazing that you were able to sort that out!

Grace,

If your skin is terribly sensitive and the pain is from abrasion of the skin, capsaicin probably won't work. (I have, until recently, had very sensitive skin on my feet - terrible blisters, couldn't ever wear flip-flops, etc. Something seems to have changed as I can now wear flip-flops - Yay! And, I rub skin lotion into the inside of new leather shoes - a trick I learned in Pakistan - before I wear them which makes a huge difference!) But, if the pain is from the nerves in the skin and the skin is not inflamed or blistered, it capsaicin cream should do the trick.

Trigeminal neuralgia, for instance, is often set off by a slight breeze on the affected cheek. Strangely, a slight breeze is a more likely trigger than a strong wind but that can do it, too. So, slight stimulation to the skin of the face can cause terrible pain in a nerve. I see no reason why the same think could not happen on the foot.

So, if your skin is not red, broken, blistered or inflamed... yay!

June,

I can't tell you what an enormous smile I had on my face while reading your message! That makes me feel so good!!! Thank you for sharing! Yay!

Diva,

Discovering Capsaicin has changed my life. Those of us who use it and get such effective pain relief simply cannot understand why people are not singing it's praises from the rooftops. But, the Pharma industry is not going to make huge money from topical capsaicin and will lose revenue from some drugs like Tegretol (which I took until it stopped working), neurontin (which had wicked side effects), SSRIs like Cymbalta (which have a significant side effect profile and dependency issues), etc.

It seems totally crazy to me that topical capsaicin is not the first choice, at least a trial, when chronic neuropathic pain is an issue.

From Koan to gracenote: So, if your skin is not red, broken, blistered or inflamed... yay!

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This reminds me of something I read last night an interview with Thich Nhat Hanh.

Q. What is happiness?

A. Happiness is the cessation of suffering. Well-being. For instance, when I practice this exercise of breathing in, I'm aware of my eyes; breathing out, I smile to my eyes and realize that they are still in good condition. There is a paradise of form and colors in the world. And because you have eyes still in good condition, you can get in touch with the paradise. So when I become aware of my eyes, I touch one of the conditions of happiness. And when I touch it, happiness comes.

Q. And not just the material things, but the fact that we have our breath.

A. Yes. You need the practice of mindfulness to bring your mind back to the body and establish yourself in the moment. . . . Happiness is possible. And this practice is simple enough for everyone to do.

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So breathing in, I am aware of my feet. Breathing out, I smile to my feet and know that my feet still function normally. I feel grateful for my feet.

I just returned from having dental Xrays and have two abscesses needing root canals (sigh) but application of topical capsaicin so effectively controls the pain that, not only am I not in pain but, I barely felt it when she did the tapping the teeth thing. I'm thinking that I should probably apply liberally in the days before the root canals!

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Very interesting!

Soon as i'm well enough my amalgam is coming out, but my main concern has been how I cope with potential pain. My nerves are hyper sensitive and there's no way I'm having local aneasthetic

From Diva: A little miracle, yes! It certainly did the trick for my leg / feet pains - a huge help and a welcome relief.

I'd love a big enough tube that I could walk into it and it would take away all the FM pains!!
Glad it's helping with so many of your pains & thanks for writing about it here as it reminded me to get some more to keep on hand.

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From Koan: But, if the pain is from the nerves in the skin and the skin is not inflamed or blistered, it capsaicin cream should do the trick.

Trigeminal neuralgia, for instance, is often set off by a slight breeze on the affected cheek. Strangely, a slight breeze is a more likely trigger than a strong wind but that can do it, too. So, slight stimulation to the skin of the face can cause terrible pain in a nerve. I see no reason why the same think could not happen on the foot.

So, if your skin is not red, broken, blistered or inflamed... yay!

Discovering Capsaicin has changed my life. Those of us who use it and get such effective pain relief simply cannot understand why people are not singing it's praises from the rooftops.

It seems totally crazy to me that topical capsaicin is not the first choice, at least a trial, when chronic neuropathic pain is an issue.

I just don't get it.

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HELP!!! :Sign Help: HELP!!!​

Did I say Help?

Here is my story.

My skin is not broken, blistered or inflamed. I went looking for Capsaicin first in the health food store (because I was there); the only formulations they had included a lot of other ingredients, but not the concentration of Capsaicin. So I went to the drug store. There were two concentrations. One came as roll on; definitely the one for me no chance of getting it in my eyes! Odor Free and No Touch Applicator. 0.15%. Bingo. I bought it.

Wednesday night I decided to try it on the top of my right foot (a spot about 3" diameter) and the end of my index? toe (whatever it's called). It burned. It burned a bit worse than the pain I was trying to eliminate, but if this will work in the long term I'm all for it. That's all I used of it.

Today, I was still noticing a little bit of stinging feeling where I applied the Capsaicin, not bad, but different than usual. Still okay.

Just a short while ago I got in the shower. This is a day and a half later. The very warm (not really hot) water on the top of my foot started burning quite a bit. It got so uncomfortable that I ended up trying to keep that foot out of the water, and then doing a flamingo while leaning against the shower wall. Not okay.

Now, 15 minutes later, the top of my foot is quite red (and my big toe is a little whitish). It feels a little sunburned-like, but not bad.

I'll be doing the freezing plus heavy duty capsaicin for a couple of weeks first! I don't do root canals without freezing even though it often is not completely effective, especially when there is infection... still, I want meditation, hot peppers, freezing and maybe nitrous! 'cept I think I heard Nitrous oxide is bad for us so maybe not.